Have you or your loved ones ever had a pinching feeling at the bottom part of your squat? Does it kind of feels like it's deep in your groin? Do you really have to warm-up a lot to make it go away? If so call...
Seriously though if you have this feeling you might have some type of impingement going on in your hip known as femoral acetabular impingement (FAI).
This is a common problem in young athletes and is often misdiagnosed (1). It can eventually cause a more serious condition known as a labral tear of the hip. Research shows us that patients visit on average 3.3 healthcare providers over a period of 21 months before being correctly diagnosed with a labral tear (2).
Here's the deal. Your hip is a ball and socket joint. The head of the femur (long bone in your thigh) comes to a head and fits into a socket called the acetabulum. The acetabulum is part of your pelvis, a bone that sits between the hips and attaches to the base of your spine. (3).
- source: www.mayoclinic.com
At the bottom position of the squat we can sometimes get the head of the femur (ball portion) to butt up against the acetabulum (socket). This can be pretty uncomfortable to say the least.
Unfortunately, you've got a structure that encapsules the hip joint known as the labrum. The labrum can become trapped between the femoral head and acetabulum and become "impinged" during a deep squat. Some individuals can get this same impingement during other activities like running and jumping. This is the phenomenon known as femoral acetabular impingement (FAI) and in the long run it can lead to labral tears in the hip. There are a few good clinical tests to see whether or not you've got this problem (4).
FABER and FADIR tests
If these tests reproduce the same pain you've been getting in your hip, you might have some impingement going on.
Notice how similar this position is to a squat gone bad...
Unfortunately this pinching is sometimes the result of a boney abnormality that can't be corrected easily. The two types of deformities are CAM deformities, Pincer deformities or a combination of both (Mixed) (1).
- source: orthoinfo.aaos.org
Cam deformity: This boney deformity is from the femoral head (ball).
Pincer deformity: This boney deformity is from the acetabulum (socket).
As you can see from the images, having these boney deformities is really going to increase the amount of impingement we get when doing something like a deep squat. In fact, those with these deformities have limited pelvic and hip motion during squats when compared to normal hips (5)
The way we can rule these conditions out is with an X-ray. If you've got symptoms of femoral acetabular impingement( FAI) it would be wise to consult your physician to see if you've got one of these boney abnormalities. On top of that, having these boney deformities and a subsequent flexibility limitation at the hip (internal rotation deficit) can lead to pain in the lower back (6) and at the pubic symphysis (7), more reason to go see your doc.
The issue with having chronic femoral acetabular impingement is that over time this can lead to a labral tear. Once your labrum is torn we can only repair it through surgery. What do you think that means for you if you continue to push through your pain?
An interesting dilemma: What came first, the chicken or the egg?
Bones in our body grow when they are stressed. This phenomenon is known as Wolf's Law. This means that if I chronically put pressure on my bones they will become stronger and more dense. It also means that if I put an abnormal stress on my bones I can grow some bone in a place that isn't meant to have any bone.
The question to ask is whether or not people are born with a boney abnormality of the hip or they develop a boney abnormality because they are chronically stressing an area and as a result develop a boney abnormality. ie: If you keep impinging your hip, your hip might grow some bone in the area where it is getting stressed.
What I mean by that is that if we chronically move in a way that promotes impingement of the hip, our body could respond by growing one of these pincer or cam deformities.
We might not be born with these boney problems, we may be creating them. So it is of the utmost importance to take care of these issues as they come up because we may be developing permanent boney abnormalities by continuing to exercise with pain and discomfort.
In part two we'll discuss some fixes to these problems and some modifications for athletes who have pinchy hips when they squat.
Until next week try some box squats,
Dan
P.S. If you enjoyed this article then head over to www.fitnesspainfree.com and sign up for the newsletter to keep up to date with new information as it comes out and exclusive deals and offers from new products and offers from yours truly.
References:
1. Roling MA., Pilot P, Krekel PR, & Bloem RM, (2012). Femoroacetabular impingement: frequently missed in patients with chronic groin pain. Ned Tijdschr Geneeskd, 51(156), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23249508
2. Burnett RS, Della Rocca GJ, Prather H, et al. Clinical presentation of patients
with tears of the acetabular labrum. J Bone Joint Surg Am 2006;88:1448–57.
3. Behnke, R. S. (2006). Kinetic anatomy. (2 ed., pp. 35-56). Champaigne, IL: Human Kinetics.
4. Reiman, MP, et al. Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis. Br J Sports Med. 2012
5. Lamontagne M, Kennedy MJ, Beaule PE. The effect of cam
FAI on hip and pelvic motion during maximum squat. Clin Orthop
Relat Res. Mar 2009;467(3):645-650.
6. Reiman MP, Weisbach PC, Glynn PE. The hips influence on low back pain: a distal link to a proximal problem. J Sport Rehabil. 2009;18(1):24-‐32.
7. Verrall GM, Hamilton IA, Slavotinek JP, et al. Hip joint range of motion reduction in sports-related chronic groin injury diagnosed as pubic bone stress injury. J Sci Med Sport. Mar 2005;8(1):77-84.
